Referral & Prior Auth Rep III

Rochester, NY

POSITION SUMMARY:

Using excellent customer service skills and exercising thorough knowledge of hospital policy and procedures as they relate to inpatient, outpatient, or ancillary intake, financial, credit and charity policies throughout the continuum of care: arranges for admission of patients to inpatient and outpatient beds and services, schedules and assigns accommodations or service locations; determines financial eligibility, secures account for billing and coordinates account management through discharge Completes appropriate forms to complete Death Certificate registration. Is familiar with the New York State Electronic Death Registry System. Maintains current knowledge of the software system used by UR for all activities concerning Bed Management.

SUPERVISION AND DIRECTION EXERCISED :

Monitors own performance on assigned tasks against procedure standards. May train and coordinate activities of peers or lower classified support staff as directed by supervisor. May work in a self-directed group.

MACHINES AND EQUIPMENT USED :

Standard office equipment, including but not limited to: computer, telephone, pneumatic tube system, printer, photo copier/scanner, fax.

TYPICAL DUTIES :

  1. Interprets eligibility for admission/service/treatment plans. Documents in a timely, accurate manner in the hospital computer system. Maintains and monitors patients in the system for accurate charges throughout all inpatient stays. Provides information to Financial Counseling in a timely manner for all urgent admissions. Marks patients for merge and notifies Health Information Management.

  2. Exercising tact, initiative and independent judgment based on financial and other pertinent information available: assigns accommodations and assists with coordination of patient transfers and discharges. Understands the complexity of the 18 units that have multiple levels of care and accommodation codes. Notifies Facilities regarding use of negative pressure rooms to ensure testing completed before patient placed in negative pressure. Books reservations for prospective patients and guests, and follows established procedures to assure a smooth, timely preadmission/preregistration/registration process.

  3. Physician relationships: Discusses pending admissions/services with physicians and their office to assure proper information is received. Confers with physician regarding postponement of elective admissions/services. Assists physicians with administrative details relating to decedent affairs such as autopsy consents, accuracy and completeness of death certificates, and liaison with the Medical Examiners’ Office. Notifies attending, referring and PCP that patient has been admitted to an inpatient service.

  4. Collaborates with health care providers to facilitate patient services.

  5. Audits and reconciles daily bed census or other patient/customer counts

  6. Must have a basic understanding of Central Registration, Health Information Management, Financial Counseling, and Pathology staff i.e. morgue in order to provide afterhours coverage for those areas.

  7. Knowledgeable and proficient in the use of the Hospital software i.e. EPIC.

  8. Exercise independent judgement in apply application of complex multi-factorial guidelines i.e. non-viable live birth and fetal death.

  9. Act as a liaison for Funeral Home Director’s and as a resource for SMH staff

  10. Screen admit orders for code able diagnosis and correct attending and services

  11. Understand the extended number of treatment programs and treatment locations that complicate the admission process

  12. Exercises considerable judgement in patient flow, direct responsibility in expediting patient movement and improving utilization of the hospital resources.

  13. Track the completion of a release of OR admission orders to facility movement from the PACU to the pt units

  14. Actively assist providers and unit staff in the use of EPIC for medical information and billing.

  15. Cognizant of the changes that are generated with bed request and assigning patients to beds in order to facilitate the correct charges number and complexity of the census reconciliation checklist.

  16. May perform other duties assigned by the managers such as statistical reports, correspondence, and other record maintenance.

  17. Assist in Transfer Center taking referrals, nominating films, scanning of face sheets into EMR, complete initial intake for transfers and consults in EMR.

QUALIFICATIONS :

AAS in related discipline with 3 years of related (admitting/registration/patient accounts/insurance) experience, preferably in a hospital setting; or an equivalent combination of education and experience. Ability to use medical terminology required.

NOTE: This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $19.08 - $25.77 Hourly

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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Location: Strong Memorial Hospital
Full/Part Time: Full-Time
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